Questions and Answers about Endocarditis - Transcript
Specialties: Adult acquired heart disease (including aneurysms of the thoracic aorta); reconstructive valve surgery; heart and lung transplantation; reoperations; endocarditis; complex coronary artery surgery; aortic and mitral valve repair/replacement (including the Ross procedure); and adult congenital heart surgery.
Good morning I am Doctor Gosta Pettersson with the Department of Thoracic and Cardiovascular Surgery at the Cleveland Clinic and this morning I want to talk to you about a disease called endocarditis.
There are many diseases of the heart, of course, and one of the complications to many of them is endocarditis. Endocarditis means infection inside the heart. Bacteria enter the bloodstream on a daily basis with many of our daily activities. We have bacteria on our body and in the openings of the mouth, and in the bowel, and occasionally in the urinary tract.
Everyday when we eat, when we chew, when we swallow bacteria get into the blood stream. Normally these bacteria are taken care of by the immune system; they are eaten and destroyed by our white cells. If, however, we have an injury to the surface inside the heart, on a valve or somewhere else, these bacteria can attach to the damaged area. And there they start to grow and stimulate formations of something we call vegetations, which is a combination of clot and bacteria. The bacteria hide inside these clots. Bacteria are proliferating and they produce enzymes. It is these enzymes which cause damage to the heart structures. It causes damage on the valve tissue on which they sit, and it can also open a way for invasion of the bacteria into the structure of the heart and cause destruction there. These destructions may cause perforation of the valves, and the valve becomes leaky, or if the bacteria invade the structure of the heart they cause abscesses. And, of course, these abscesses can eventually rupture back to the circulation, or rupture somewhere else with very serious consequences.
From the vegetations itself, small pieces of tissue can break off and go to different parts of the body. The most serious consequence would be if a piece of tissue went to the brain. It would there cause a stroke which is a common complication to endocarditis. You can understand from this description how very important it is this disease is recognized and treated early.
If treatment is started before there is any invasion or destruction of tissue, you can cure the infection without severe damage to the heart and without complications arising. The symptoms you get are those of any infection and it is only if you belong to one of the risk groups (if you have and artificial valve or any other know structure or heart disease) that you, of course, have to go to the doctor immediately when you get signs of infection. If the infection is not recognized and treated immediately with antibiotics, you may need surgery to handle the infection.
Surgery may be needed because of valve dysfunction or because the infection has invaded the heart in such a way that it is not any more curable with antibiotics alone. This surgery may be a simple valve surgery or it may be very complicated and difficult surgery depending on what stage we are allowed to get the patient and do the surgery. It is very seldom that the damage to the heart is so bad that we cannot handle that problem surgically.
It may be a surgical challenge, but we’ve developed a lot of experience with management of these problems and today we have very good solutions for the reconstructions which are associated with a very low risk of infection coming back. Surgery alone will never cure the infection, but all patients, in addition to surgery, should be treated with antibiotics.
The patient will get intravenous antibiotic treatment as decided by the sensitivity of the organism to the antibiotics for at least six weeks from the day of surgery. Six weeks will also be the minimal treatment for a patient who will not require surgery. One third of the patients will require surgery in the acute phase, one-third will require surgery later in the course and about one third of the patients with endocarditis are cured without need for surgery.
Prophylactic antibiotics is advised to all patients who have risk of getting endocarditis and that includes all patients with prosthetic valves in the heart and patients who have other structural heart disease including valve disease and congenital heart disease.
I hope that you’ve found the information about endocarditis interesting and worth while. Thank you.
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